TRT, mental fatigue, and cycling

[hyperCat]

So I've been on TRT for a little over a year now (Androgel, 4 pumps). This has brought my T level up between 500-600. However, I still tend to feel lethargic and mentally "off" more than I think I should. I have tried supplementing with some dhea and pregnenolone, with only minimal improvements. TRT has definitely helped with libido, but I was hoping it would improve energy levels and mood more than it has.

I have also found that if I try to start a cycle of anything these days (whether it's trest, dmz or lgd), I basically end up stopping after about 4-5 days due to extreme mental fog and lethargy. Processing thoughts become very difficult and I simply can't perform my job in that state. I also feel slightly depressed at times and lack motivation.

As far as scripts go, I also take .5 mg of clonazepam and 20mg of nadolol in the mornings, and .25 mg of clonazepam at night. For supplements, I take Vit d, fish oil, niacin, NAC, magnesium/potassium. As mentioned, I was supplementing with 50mg dhea and 5mg of preg, but have recently stopped that because I didn't feel it was really helping. I have recently been taking .25mg of liquidex eod thinking it could be high estro, and I haven't felt quite as lethargic since then. Still not great, but better. Granted I should probably get a blood workup done, and I plan to do that soon.

My questions:

1) what is the chemical reason for a cycle to cause such mental fog? Is it known what kind of brain chemistry causes this?
2) are any of you on TRT and still feeling lethargic?
3) what is the relationship between serotonin and dopamine? I know there are supplements that can affect levels of each one. Does anyone have any recommendations what supplements I could add that might "normalize" levels of both?

Any feedback appreciated. BTW, Im 46 yrs old, so not a young stud anymore! Just trying to elevate my mood, energy and hopefully figure out how to run a reasonable cycle without the mush-brain.

 

[kisaj]

Well first off, the two main side effects of klonopin are problems with memory and brain fog, with lethargy running next. So, I would venture to guess this is largely in play. Also, any BP medication can sap motivation and adding it to the clonazepam is like putting together a lazy, mentally slowing stack. With that being said, to your questions with the best of my knowledge:

1) As mentioned above. You are taking scripts that are known to cause the side effects you are mentioning.
2) On TRT going on 7 years now. More energy than I know what to do with and I have never experienced much lethargy since starting. This will go into the next question.
3) The relationship between seratonin and dopamine is inseparable. Serotonin is your relaxing, feel good, anxiolytic neurotransmitter. It regulates your moods essentially. Dopamine is your pleasure neurotransmitter and is responsible for motivation, libido, mood, and confidence. You need them in a balance or you can very easily see changes in your behavior. High serotonin and low dopamine will have you feeling flat, emotionless, and tired. High Dopamine will have you feeling overly anxious, aggressive, high libido, and usually involve sleep issues. The two most common ways to supplement and I would recommend on TRT are to take 5HTP in the evening and l-tyrosine in the mornings in a 1:10 ratio. 5HTP boosts serotonin levels and l-tyrosine boosts dopamine. So for a 1:10 ratio you would take 50mg 5HTP and 500mg l-tyrosine- both very common dosages available.

Trust me when I say that everyone, especially those on TRT, can benefit from a boost in dopamine.

 

[hyperCat]

Awesome info kisaj! Appreciate your time in responding. I knew the klonopin probably wasn't helping with energy, but it's how I have been dealing with some fairly stressful work situations. Definitely knocks down the anxiety, and luckily I haven't gone off the deep end with higher doses. I was only taking .25 mg twice a day, but recently bumped it up slightly because it wasn't quite taking the edge off. Definitely going to try the 5HTP and tyrosine combo. I feel pretty sure that my serotonin/dopamine levels are probably not optimal, so we'll see where this goes.

If I start feeling more edgy with this combination (as I'm prone to anxiety), would you raise the 5HTP or lower the tyrosine? I'll probably order these in lower dose pills so I can be flexible with dosing as I try to find a sweet spot.

Thanks again...

 

[kenpoengineer]

Well first off, the two main side effects of klonopin are problems with memory and brain fog, with lethargy running next. So, I would venture to guess this is largely in play. Also, any BP medication can sap motivation and adding it to the clonazepam is like putting together a lazy, mentally slowing stack. With that being said, to your questions with the best of my knowledge:

1) As mentioned above. You are taking scripts that are known to cause the side effects you are mentioning.
2) On TRT going on 7 years now. More energy than I know what to do with and I have never experienced much lethargy since starting. This will go into the next question.
3) The relationship between seratonin and dopamine is inseparable. Serotonin is your relaxing, feel good, anxiolytic neurotransmitter. It regulates your moods essentially. Dopamine is your pleasure neurotransmitter and is responsible for motivation, libido, mood, and confidence. You need them in a balance or you can very easily see changes in your behavior. High serotonin and low dopamine will have you feeling flat, emotionless, and tired. High Dopamine will have you feeling overly anxious, aggressive, high libido, and usually involve sleep issues. The two most common ways to supplement and I would recommend on TRT are to take 5HTP in the evening and l-tyrosine in the mornings in a 1:10 ratio. 5HTP boosts serotonin levels and l-tyrosine boosts dopamine. So for a 1:10 ratio you would take 50mg 5HTP and 500mg l-tyrosine- both very common dosages available.

Trust me when I say that everyone, especially those on TRT, can benefit from a boost in dopamine.

Awesome information - will you be my TRT doctor? Will be taking this recommendation. Thank you.

 

[hyperCat]

Quick update - I started taking this 5htp/tyrosine stack Friday - 50mg/500mg ratio. So it's only been a few days, but the past two nights I haven't been able to sleep very well, and during the night my heart rate seems faster. A little more anxious too.

Would this most likely just be my body chemistry adapting to these new supps, or should I consider adjusting the dose this soon? As I understand, it's the tyrosine that is probably more likely the cause for sleep disturbances, although I have been taking it at 7am. If I adjust the doses, should I lower the tyrosine or raise the 5htp? Just looking for a little more guidance here...

 

[kisaj]

Taking l-tyrosine in the morning should not be affecting sleep at night, even though it is increasing dopamine. I'd stop the 5HTP and assess if it were me, then if that helps, I'd add it in eod and check.

Unfortunately there is no magic answer and like with anything, takes some trial and error. What works for many, may require adjustment, especially since you are on a benzo.

 

[hyperCat]

Wow, looks like I'm super sensitive to 5HTP. I stopped taking the tyrosine and 5htp for a couple of days, then started the tyrosine again at half the dose. Everything seemed ok. Last night I took what was probably about 20mg of 5HTP, and bam, up in the middle of the night with the same feeling as before - rapid heart rate and pretty nasty anxiety. Couldn't get back to sleep.

Any ideas why I respond this way to 5HTP? Just extreme sensitivity to changes in serotonin? Something else? Looks like I won't be touching 5HTP anymore. Any problems with continuing with the tyrosine as long as I don't have any bad reactions to it?

 

[kisaj]

Yep, I suspected. I wouldn't say it's common, but people do sometimes have trouble with 5htp.

A thought to allow a more natural balance of dopamine and serotonin as well as other health benefits would be to supplement Sam-e. You should drop the L-tyrosine if you decide to try that and then add in as needed.

 

[hyperCat]

Thanks kisaj. I'm going to continue with just the tyrosine for now to see how that works. The night before that, I slept pretty well, so I'll give it some more time to see what kind of improvements i see in my mood and energy levels. I plan on ramping the dose slowly back up to 500mg, so we'll see where it goes from there.

 

[sammpedd88]

In reference to 5HTP.... I've read that taking Tryptophan is the better due to the way it coverts to 5HTP in the body. Of course that would be for people that really need to supplement it. My 17 year old son has taken low doses of 5HTP to help with mild anxiety. It helped him sleep and made him less anxious. Gonna have him take Tryptophan instead.

 

[kisaj]

Hmm, I don't know about that. Can you reference where you read that? That goes against everything I've ever studied on the two. The only thing I could possibly think would make tryptophan better would be the enzyme responsible for the conversion helping control serotonin levels allowing it to be managed a little more like natural.

 

[hyperCat]

Similar to what I read, where tryptophan doesn't bypass the body's ability to rate-limit serotonin levels like 5HTP. I may have misinterpreted what I read though.

 

[sammpedd88]

Hmm, I don't know about that. Can you reference where you read that? That goes against everything I've ever studied on the two. The only thing I could possibly think would make tryptophan better would be the enzyme responsible for the conversion helping control serotonin levels allowing it to be managed a little more like natural.

You hit the nail on the head with the managing it as natural as possible. I'll dig up the site and post it.

 

[kisaj]

My concern with that would be that anytime there is an extra step in conversion you stand the possibility of losing some effect and efficiency. With 5-htp, it converts directly to serotonin so the effects are more (studies state) pronounced.

I honestly don't know first hand as I have never taken l-tryptophan.

 

[Spurfy]

So I've been on TRT for a little over a year now (Androgel, 4 pumps). This has brought my T level up between 500-600. However, I still tend to feel lethargic and mentally "off" more than I think I should. I have tried supplementing with some dhea and pregnenolone, with only minimal improvements. TRT has definitely helped with libido, but I was hoping it would improve energy levels and mood more than it has.

I have also found that if I try to start a cycle of anything these days (whether it's trest, dmz or lgd), I basically end up stopping after about 4-5 days due to extreme mental fog and lethargy. Processing thoughts become very difficult and I simply can't perform my job in that state. I also feel slightly depressed at times and lack motivation.

As far as scripts go, I also take .5 mg of clonazepam and 20mg of nadolol in the mornings, and .25 mg of clonazepam at night. For supplements, I take Vit d, fish oil, niacin, NAC, magnesium/potassium. As mentioned, I was supplementing with 50mg dhea and 5mg of preg, but have recently stopped that because I didn't feel it was really helping. I have recently been taking .25mg of liquidex eod thinking it could be high estro, and I haven't felt quite as lethargic since then. Still not great, but better. Granted I should probably get a blood workup done, and I plan to do that soon.

My questions:

1) what is the chemical reason for a cycle to cause such mental fog? Is it known what kind of brain chemistry causes this?

LH, which is shutdown during TRT, is needed to activate the P450scc pathway, to produce pregnenolone and cortisol. You feel like garbage because your cortisol levels, which is *the* most important hormone in your body, btw, are chronically low.

2) are any of you on TRT and still feeling lethargic?

No. I take 60 mg of toremifene per day and have a fully HPG-axis and fully functioning balls.

3) what is the relationship between serotonin and dopamine? I know there are supplements that can affect levels of each one. Does anyone have any recommendations what supplements I could add that might "normalize" levels of both?

Waste of time. Low cortisol is your problem.

Any feedback appreciated. BTW, Im 46 yrs old, so not a young stud anymore! Just trying to elevate my mood, energy and hopefully figure out how to run a reasonable cycle without the mush-brain.

Either run a SERM, get on hCG, or supplement with hydrocortisone tablets -- 20-30 mg/day in divided doses. Any of these will fix your low energy and brain fog problems.

 

[hyperCat]

I've been still trying to figure this out, and this makes a lot of sense. I've been suspecting adrenal fatigue, but just didn't quite understand how important cortisol is. Couple of questions:

1) Is cortisol to blame for the sudden anxiety I sometimes get during the night when I'm not sleeping well? Or is that adrenaline?
2) Are the things you mentioned things I would have to continue taking, or would my adrenals finally start working better on their own?
3) Would ralox be sufficient? If so, what dose? Don't think I could get my hands on hyrdrocortisone tabs unless there are ways I don't know about.

Appreciate the response Spurfy, and it sounds like you are spot on.

 

[Spurfy]

I've been still trying to figure this out, and this makes a lot of sense. I've been suspecting adrenal fatigue, but just didn't quite understand how important cortisol is. Couple of questions:

1) Is cortisol to blame for the sudden anxiety I sometimes get during the night when I'm not sleeping well? Or is that adrenaline?

Low cortisol means that the hypothalamic effects of epinephrine and norepinephrine are not able to be mitigated. Cortisol calms the limbic system and lets your pre-frontal cortex continue to work during fight or flight. So, yes, it sound like low nighttime cortisol is triggering a blood sugar crash that is waking you up. Complex carbs at bedtime might help dramatically.

2) Are the things you mentioned things I would have to continue taking, or would my adrenals finally start working better on their own?

Your adrenals are fine -- it's your hypothalamus that's screwed up. "Adrenal fatigue" isn't real, but neuro-endocrine-immuno dysregulation is. What people think is "adrenal fatigue" is long-term stress-induced hypothalamic damage which results in lowered baseline cortisol production and a blunted stress response.

3) Would ralox be sufficient? If so, what dose? Don't think I could get my hands on hyrdrocortisone tabs unless there are ways I don't know about.

Doubtful. It is very weak at stimulating the HPA-axis. Toremifene would be ideal -- PM me for more info.

Appreciate the response Spurfy, and it sounds like you are spot on.

You are welcome, and I am. I never present anything I'm not certain of.

 

[kisaj]

Not to question you as it is apparent you have an understanding of what you are posting, but how can anyone be certain of what is happening. The only way to know is to get cortisol levels checked.

 

[Spurfy]

Not to question you as it is apparent you have an understanding of what you are posting, but how can anyone be certain of what is happening. The only way to know is to get cortisol levels checked.

Cortisol tests, other than 24-hour salivary, are useless, and this test only gives baseline cortisol, it cannot measure glucocorticoid reactivity of the HPA-axis to stress. To measure a blunted stress response requires fMRI and a lot of blood work, so, we diagnose this symptomatically. This is just how it is.

 

[kisaj]

Ok, I won't pretend to know differently so I'll take your word for it.

 

[Spurfy]

Ok, I won't pretend to know differently so I'll take your word for it.

Endocrinology -- it's 75% science and 25% intuition.

 

[kisaj]

Based on my 8 years of working with endos, I'd go more 50/50. lol

 

[Spurfy]

Based on my 8 years of working with endos, I'd go more 50/50. lol

I was being very generous...

I'm not a physician, I'm a researcher, but I do interact regularly with them. Some are very, very good. Most are marginal, at best. Some are absolutely useless. The useless ones go 100% science -- the science supporting endocrinology is very, very flawed.

 

[kisaj]

I would agree with you based on personal experience having dealt with 3 different endos and having ties into many hormone doctors and internalists. The science is generally flawed and cannot be applied as a blanket across a population. Every situation is different.

 

[hyperCat]

Doubtful. It is very weak at stimulating the HPA-axis. Toremifene would be ideal -- PM me for more info.

You are welcome, and I am. I never present anything I'm not certain of.

PM sent...

 

[Spurfy]

I would agree with you based on personal experience having dealt with 3 different endos and having ties into many hormone doctors and internalists. The science is generally flawed and cannot be applied as a blanket across a population. Every situation is different.

You're exactly right. Reference ranges are just that, and symptoms are more important than these arbitrary numbers that are wholly unscientific.

If a patient complains of feeling cold, has a basal temp of 96.6, bradycardia, and low energy, then a TSH "in range" is meaningless. This patient is clearly hypothyroid and should be started on T3 at once. Even free T3 in range is still not as important as symptoms in this instance, because we don't know what is going on at the molecular level. Cellular T3 uptake can be impaired by numerous factors, low cortisol being one.

 

[trn450]

I was being very generous...

I'm not a physician, I'm a researcher, but I do interact regularly with them. Some are very, very good. Most are marginal, at best. Some are absolutely useless. The useless ones go 100% science -- the science supporting endocrinology is very, very flawed.

That's much of medicine though, to be honest.

For quite a while people emphasized the art AND science of medicine. In the context of insurers and other organizations imposing strict regulations on providers meeting quality of care metrics based on very lower resolution analyses of broad patient populations the art portion, which is needed to fill the gaps to some degree IMO, is disappearing.

I'm an Internist, and that's been my experience.

On that note, I recently had a cousin admitted to the hospital. Cerebral palsy, but normal IQ. For a number of reasons, he had a perfect storm of sorts contribute to the development a delirium. I know that anytime a person presents with altered mentation we've got to make sure anything that might kill said patient needs to be ruled out. And, that was done. But, when there was nothing left, I was surprised that neither the Internist nor the Neurologist knew what to do.

Treating delirium is a bit of an art in it's own right. I had to go down there on a couple of occasions and teach the family how to deal with it. Otherwise the entire team was content to just let him sit in his bed, sleep for 90% of the day, and in his 10 waking minutes he'd be lethargic and non-sensical. Was very disheartening.

 

[Cycloman]

So I've been on TRT for a little over a year now (Androgel, 4 pumps). This has brought my T level up between 500-600. However, I still tend to feel lethargic and mentally "off" more than I think I should. I have tried supplementing with some dhea and pregnenolone, with only minimal improvements. TRT has definitely helped with libido, but I was hoping it would improve energy levels and mood more than it has.

I have also found that if I try to start a cycle of anything these days (whether it's trest, dmz or lgd), I basically end up stopping after about 4-5 days due to extreme mental fog and lethargy. Processing thoughts become very difficult and I simply can't perform my job in that state. I also feel slightly depressed at times and lack motivation.

As far as scripts go, I also take .5 mg of clonazepam and 20mg of nadolol in the mornings, and .25 mg of clonazepam at night. For supplements, I take Vit d, fish oil, niacin, NAC, magnesium/potassium. As mentioned, I was supplementing with 50mg dhea and 5mg of preg, but have recently stopped that because I didn't feel it was really helping. I have recently been taking .25mg of liquidex eod thinking it could be high estro, and I haven't felt quite as lethargic since then. Still not great, but better. Granted I should probably get a blood workup done, and I plan to do that soon.

My questions:

1) what is the chemical reason for a cycle to cause such mental fog? Is it known what kind of brain chemistry causes this?
2) are any of you on TRT and still feeling lethargic?
3) what is the relationship between serotonin and dopamine? I know there are supplements that can affect levels of each one. Does anyone have any recommendations what supplements I could add that might "normalize" levels of both?

Any feedback appreciated. BTW, Im 46 yrs old, so not a young stud anymore! Just trying to elevate my mood, energy and hopefully figure out how to run a reasonable cycle without the mush-brain.

Hey bro - just a quick thought, have you ever had your thyroid checked? Low thyroid could give a whole host of symptoms – especially brain fog and fatigue – and that despite having good testosterone levels. You might want to check that out. By the way, I'm just a few years older than you and went through the same thing – turned out I have low thyroid – and that was part of the issue. Also, I've found adding DHEA to my TRT protocol helped a lot. In men our age DHEA is about 1/2 of the level it was when we were younger. Lastly, HCG with TRT was a great addition for me (I'm on 4 pumps of Androgel as well)

 

[hyperCat]

Hey bro - just a quick thought, have you ever had your thyroid checked? Low thyroid could give a whole host of symptoms – especially brain fog and fatigue – and that despite having good testosterone levels. You might want to check that out. By the way, I'm just a few years older than you and went through the same thing – turned out I have low thyroid – and that was part of the issue. Also, I've found adding DHEA to my TRT protocol helped a lot. In men our age DHEA is about 1/2 of the level it was when we were younger. Lastly, HCG with TRT was a great addition for me (I'm on 4 pumps of Androgel as well)

Appreciate the post - yeah, I did have my thyroid checked and it was fine. Earlier in this thread, one of the AM members suggested I try a serm. I feel so much better after being on a serm now for a few weeks. Never even considered the whole cortisol/LH thing being out of whack. But I will say, the serm has absolutely helped with just about every issue I was having - lethargy, fatigue, insomnia, fogginess. Still wouldn't say I'm completely back to normal, but as normal as I've felt in a pretty long time. So much so that I decided to do a light trest cycle. I'm a week in and feel really good. Before, I would have to stop a cycle after 3-4 days because I just couldn't deal with the extreme fatigue and brain fog. I was bad enough as it was, and androgens seemed to push me beyond what I could handle.

So for now, I'm going to keep dosing a serm for a few more weeks, then probably cycle off for a while to see how things go. I'm just glad to have found something that works for me. And yeah, I supplement my TRT with 10mg DHEA and 5mg pregnenelone ed.

And one last thing, Spurfy gets a fair amount of heat because of his recommendations on the board, but he definitely seemed to nail my issue. Can't really argue with success, regardless of if it makes sense or not...

 

[Spurfy]

And one last thing, Spurfy gets a fair amount of heat because of his recommendations on the board, but he definitely seemed to nail my issue. Can't really argue with success, regardless of if it makes sense or not...

Thank you. I'm glad I could help. Also glad you were a N=1 test subject for raloxifene and maintaining HPG-axis function on exogenous testosterone!

And no one will find a study that supports my recommendation to run a SERM on cycle or TRT, but I have 17 years of experience in this field and if it works, it works. I don't need to back up my expertise with someone else's publication, especially given that there are but a handful of people in this country with the level of knowledge and understanding of neuropharmacology as it relates to endocrinology, as I.

So, people can take or leave my advice -- I don't care either way. I'm not posting my bloods or wasting any more time trying to convince people. They're either open-minded or they already know everything in the world.

 

[Nac]

Lol, luv it

 

[hyperCat]

Couple more questions... Since I'm on TRT, I get blood work every six months. I think it's psa, rbc, total test and liver. How will a serm affect these results? Just wondering if these readings come back significantly different than they have in the past (whether better or worse), might make the doc suspicious. I plan to stop the serm 4 weeks prior to my visit, but guessing the effects could still be reflected in the tests.

Still doing really well on the serm, tho. A couple of weeks in now on a short run with trest, and feeling pretty good. Actually added some DMZ a few days ago. Nothing heavy - 50mg trest and 15mg DMZ. Feels good being able to cycle without feeling like death and not having to end the cycle after 4 days lol.

One thing that doesn't seem consistent is the size of my balls now. Sometimes they are nice a fat, and other times they are small. I'm sure it has to do with the trest, as before that while just on TRT and the serm, they were more consistent and seemed to stay relatively plump. Kinda odd tho...

 

[Cycloman]

Serm should have very minimal effect on the areas you mentioned. Normally - Serms tend to raise SHBG which can lower Free Test a bit. Also, depending on the dosage, and where you got them from – liver values could be slightly elevated, if at all. The key with Serms is low dose Either 12.5 mg Clomid or 10 Nolvadex is all one really needs - even for PCT. there will be a lot of guys out there saying you need to run very high doses, and stacking them – but this leads to a lot of side effects for some. Keeping it at a low dose should give you the benefits you need and will not mess up your blood work at all

 

[Tearbear]

Insightful

 

[hyperCat]

Serm should have very minimal effect on the areas you mentioned. Normally - Serms tend to raise SHBG which can lower Free Test a bit. Also, depending on the dosage, and where you got them from – liver values could be slightly elevated, if at all. The key with Serms is low dose Either 12.5 mg Clomid or 10 Nolvadex is all one really needs - even for PCT. there will be a lot of guys out there saying you need to run very high doses, and stacking them – but this leads to a lot of side effects for some. Keeping it at a low dose should give you the benefits you need and will not mess up your blood work at all

Thanks for the feedback Cycloman. For now, I'm almost out of torem, but have some ralox i'm going to start on. So would you say I could run, say 30-60mg ed of ralox, up to 1-2 weeks before bloods? Or should I take more time off the serm just to be safe?

 

[Cycloman]

Personally - I'd give myself at least 2 weeks. I'm not familiar with torem or ralox - I have run Nolva and Clomid. Watch the dose (e.g. I would recommend running the equivalent of 10 mg Nolvadex. If Ralox is more potent then Nolvadex you would need less.

 

[Spurfy]

Thanks for the feedback Cycloman. For now, I'm almost out of torem, but have some ralox i'm going to start on. So would you say I could run, say 30-60mg ed of ralox, up to 1-2 weeks before bloods? Or should I take more time off the serm just to be safe?

You need at least a month off of torem, with its half-life of 5 days. For ralox, with a half life of 27 hours, you need about a week.

 

[hyperCat]

Thanks for the info!

 

[Disco41]

Ever get any blood work to check Estro, etc? Even though your test is not very high, I would think it a good idea to see things like Estro. To me, other than thyroid, E would be my first guess. And since the SERM has helped....... Just curious, i did not see if you posted any, so sorry if you did.